Swimming the lab work funnel

How much time do you spend on lab work? I’ve been advised to “rethink the funnel”. I’m a GP. Most of us are. Family docs are at the bottom of the pile, which sounds awful, but it’s the truth. We’re the gatekeepers, the initial assessors, the most accessible physician in the system. Patients come to us with their concern, we do an assessment, and often order tests. If we’re unsure, we refer. The consultant assesses, and orders tests. Which we get. They occasionally refer to another consultant down the hall. Who orders tests. Which we get.

IXV_1245: swimming the labwork funnelCreative Commons License Leon Brocard via Compfight

There’s the funnel. We get the tests we order, as primary health care workers, and we get copies from everybody else we refer to, and everyone else they refer to. Our patients present to ER with chest pain, and we get those tests, very appropriately. Consultants are involved, who see the patient in follow up, and order more tests. On our desk.

 

We’re the failsafe in the system. None of us want things to fall through the cracks. There are a lot of failsafes in our system…Our esteemed house staff retake and retake the history, and confer and question lab results, and often challenge us. Here’s a failsafe I think we take for granted. Our learners. There’s the pharmacist, who checks our scripts, and lets us know if it’s a drug that’s been changed by someone else, or discontinued, or somehow reacts with something that our software system hasn’t picked up.

 

But basically, the family doc is the one. Our major role is to catch stuff that falls through the cracks. Our specialty is in breadth, not depth. We often have to reach out to our specialist colleagues for their expertise. We all know we need them.

 

And we need their tests. Because patients come back to us and wonder what the heck the specialist just told them. We need them. The preliminary result, the pending result, the final result. Have you noticed that? Compared to decades ago, when the specialist would run some tests, investigate the patient, come to a conclusion and send you a summary, we now get it all?

 

Probably for the best. The information superhighway drives right through our clinics. In the past, we’d have to call the specialist, ask for the questioned results, or wait. I remember 25 years ago clearly telling patients to come back in a couple of weeks, so we could search out and gather results. Well, now it’s on our desk. The preliminary CBC, then the diff, then the thyroid results. Then the final. We’re looking at labs over and over and over and over.

 

And I don’t see any way around it.

 

“Rethink the funnel,” I’ve been advised. I’ve been advised to “turn off” information flow from selected patients that are inpatients. “You don’t need all that stuff,” they say. Well, maybe not immediately, but often yes! What of the phone calls from family we get on a daily basis? What about the patient that ends up on our doorstep the day after discharge? We have to get it.

 

I have a practice of perhaps 2000. Lab and consult report review runs from approximately 90 minutes on Monday, to a low of probably half that on Friday. That’s for my initial block of time… I come in early. Throughout the day, there’s further messages, and downloads. I imagine even on the lightest day dealing with labs and correspondence takes me over an hour. One needs to look at the lab result, see who ordered it, ensure follow up/ appropriate action, read the consult, fill the problem list, try to remember to SNOMED the diagnosis… It all takes time, and is just part of the job. But sometimes there just isn’t enough.

 

Time.

 

We’re now tasked with looking on our practices with a broader perspective, to attempt to think QIPs. Instead of just diving patient to patient, we need to try to do things better, and nudge our little cohort of patients along a better, healthier path by doing things differently.

 

The question is, when is there time to think?

 

I work on PS Suite. There are a couple of shortcuts that make things a bit faster. We have now separated results, with clinical connect coming in under one stream, and lab downloads on another. We have tried to leave the message bar at the bottom of the screen for phone calls, etc. It’s helped a bit, and messages are a bit more manageable. Call your software supplier for some ideas of how to manage your messages efficiently.

 

But the funnel exists. It’s there, and there’s no turning it off.

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